Abstract
BackgroundSingle soft tissue metastasis of medullary thyroid carcinoma is extremely rare. In addition, several occult medullary thyroid carcinomas with distant metastasis were reported, but undetectable primary lesion at diagnosis was also extremely rare.Case presentationA 74-year-old man was admitted to our hospital because of a painful nodule in his left buttock for over 1 year. Needle biopsy was performed, and the histological findings revealed adenocarcinoma positive for thyroid transcription factor-1. No evidence of a primary tumor, including the lung and thyroid gland, could be found elsewhere despite detailed examinations, including thyroid echography, chest computed tomography, and fluorodeoxyglucose-positron emission tomography. The soft tissue tumor was resected with a wide margin. Immunohistochemical analysis showed the tumor cells to be positive for cytokeratin-AE1/3, cytokeratin 7, synaptophysin, chromogranin A, calcitonin, and carcinoembryonic antigen, but negative for cytokeratin 20, Napsin A, Pax8, and p40, resulting in a diagnosis of metastasis of medullary thyroid carcinoma.ConclusionInitial presentation with a single metastasis to soft tissue and undetectable primary tumor in the thyroid gland is an extremely rare clinical manifestation in patients with medullary thyroid carcinoma.
Highlights
Single soft tissue metastasis of medullary thyroid carcinoma is extremely rare
It has been reported that clinical neck lymph node metastases are detected in at least 50% of patients [1,2,3,4,5] with Medullary thyroid carcinoma (MTC) and that distant metastases are present in 5% [5] or 10–20% [1] of cases of MTC by the time of primary diagnosis
Single soft tissue metastasis of MTC is extremely rare, several case series show an unusual presentation of distant metastases of MTC [6,7,8]
Summary
Initial presentation with a single metastasis to soft tissue and undetectable primary tumor in the thyroid gland is an extremely rare clinical manifestation in patients with medullary thyroid carcinoma.
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